Healthcare Provider Details

I. General information

NPI: 1194505156
Provider Name (Legal Business Name): LOTUS INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 SHAWNEE AVE
WINCHESTER VA
22601-5156
US

IV. Provider business mailing address

348 SHAWNEE AVE
WINCHESTER VA
22601-5156
US

V. Phone/Fax

Practice location:
  • Phone: 540-242-4480
  • Fax: 540-242-4480
Mailing address:
  • Phone: 304-406-2096
  • Fax: 540-242-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE PERKINS
Title or Position: FOUNDER
Credential:
Phone: 304-406-2096